Abstract P136: Ischemic Evaluation in Patients With Hypertensive Emergency / Urgency and Acute Systolic Heart Failure: Is Coronary Angiography Required for All?

Autor: Jared W Davis, Muhannad Almubarak, Samuel K McElwee, Amrita Mukherjee, Firas Al-Solaiman, Mark F Sasse, Massoud A Leesar, Arka Chatterjee
Rok vydání: 2017
Předmět:
Zdroj: Hypertension. 70
ISSN: 1524-4563
0194-911X
DOI: 10.1161/hyp.70.suppl_1.p136
Popis: Aim: Patients presenting with hypertensive urgency / emergency (HU/E) often have systolic heart failure(S-HF). Coronary angiography is routinely done for these patients to rule out obstructive coronary artery disease (O-CAD). We performed a retrospective study to investigate predictors of O-CAD in this population. Methods: Consecutive patients who underwent angiography to investigate S-HF and had hospital admissions for HU/E in the preceding 6 months were included in the study. Chart review was performed to obtain demographic, clinical and imaging / angiographic data. Statistical analysis was performed using SAS 9.4 software. Results: 205 patients [age 58.9 ± 14.4 years; 62.4 % male; 39.5% diabetic; median EF 25% (Inter Quartile Range: 11)] were included in the study. 33.1% patients (n=68) had O-CAD. Age > 60 years (Odds Ratio: 2.3; 95% Confidence intervals: 1.3-4.3) , Diabetes (OR: 2.1; 95% CI: 1.2-3.8), history of stroke (OR: 2.7; 95% CI: 1.1-7.0) and presence of regional wall motion abnormalities (RWMA; OR: 7.4; 95% CI: 3.4-16.1) and abnormal perfusion study (OR: 7.6; 95% CI: 1.5-39.6) were significantly associated with O-CAD while African American (AA) race was a protective factor (OR: 0.4; 95% CI: 0.2-0.8). ROC curves constructed using an age cut off of 60 years along with non AA race, diabetes and RWMA yielded a good fit with a c statistic of 0.75. Conclusions: Our results suggest that only a minority of patients with HU/E and S-HF have obstructive CAD. It may be possible to stratify patients using demographic and non-invasive tests to direct only those with high likelihood of O-CAD for coronary angiography. These results should be validated in large registry populations.
Databáze: OpenAIRE
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